Wednesday, January 30, 2013

iPod Spine: Lumbar Instability and Sacro-Iliac Joint DysfunctionStudents participated in this Blog: Brittany West, Dmitri Raetki-SolntevResearch Advisers: DR. Hamdy Radwan, Dr. Emma WhiteWelcome to our blog! This blog is designed
to assist physical therapy students, teachers and practicing physical therapists.
This blog was developed by physical therapy students and faculty of Winston
Salem State University, physical therapy department. This blog provides
detailed information and steps for administration of lumbar spine and
sacro-iliac (SI) special tests.Extensive clinical experience and a
literary review were conducted to support the use of these tests. Detailed
information is available regarding the procedure, alternative names, position
of both patient and therapist, and references to use for future research by viewers. Videos can be accessed to view the tests in action.Such statistical parameters as sensitivity
(true positive), specificity (true negative) and likelihood ratio (LR) are also
at your disposal. You will find the information about each test identifying in
what cases the test is considered positive (+) or negative (-).We hope that you will use and find this
blog helpful. Enjoy it!!!Below is the list of special tests
discussed in this blog:

Monday, January 28, 2013

Purpose: The
test can help distinguish between lumbar spine involvement and SI joint
dysfunction.

Patient/Therapist Position: Pt
is supine with crease of knee at edge of table. The leg being tested is
hyperextended at the hip so that it hangs over the table while the other leg is
flexed at the hip and knee.
Procedure: Once the pt is in the proper position; the pt actively holds the non-tested leg into hip flexion during which time the PT stabilizes the pelvis and applies passive pressure to the tested leg, in order for it to stay on the table. The PT applies overpressure so that the tested hip is put into further extension and adduction.

Procedure: The PT stabilizes contralateral (straight) leg’s ASIS. The PT then tries to passively lower the tested leg to the table. 1

Interpretation: + indication when pain is reproduced with comparable symptoms and/or
when the tested leg's knee remains above the leg that is straight out.
*Note- Unaffected side should always be tested first.

Purpose: To assess for impingement of the dura and spinal cord nerve roots of the lower lumbar spine. The test targets the sciatic nerve, tibial nerve, sural nerve, common peronal nerve and nerve root (disc prolapse).
Patient/Therapist Position and Procedure: Basic SLR; Pt is lying supine with leg straight. PT then flexes hip until pt complains of pain or tightness in the lower back or radicular pain down the posterior portion of the tested leg. PT then lowers leg (which should slowly relieve pain). If no comparable symptoms occur
the PT can proceed to next SLR modification.

*Note- Unaffected leg should always be tested first.

Interpretation: + indication when pain is reproduced with comparable symptoms, radicular pain in posterior portion of tested leg, and if the pain is relieved when the PT lowers the tested leg.

Purpose: To assess for movement restriction/impingement of the dura and spinal cord and/or nerve roots. Modifications test for cervical and lumbar nerve roots, sciatic nerve, obturator nerve and femoral nerve impingements.
Patient/Therapist Position and Procedure:
Pt
is seated on edge of table, feet hanging off the table. Pt
is instructed to “slump” over into thoracic and lumbar flexion. Pt
has hands behind his/her back. Pt
is asked to keep neck and head in neutral (no flexion). If there are no
reproduction of neurological symptoms, the PT progresses to the slump test
modifications.

*Note- Unaffected leg should always be tested first.

Interpretation: + indication when pain is reproduced with comparable symptoms; if pt is unable to extend (affected) knee due to pain and then the pain is relieved when overpressure of the cervical spine is released the pt actively extends their neck.

Patient/Therapist Position: Patient positioned prone with legs off the table while toes touch the floor. Patient is to be relaxed prior to testing. Therapist is positioned on either side of the table. Therapist
places hands at suspected involved segment.

Procedure: Patient is asked to lift feet of the floor 2-3 inches and extent hips towards the ceiling. Therapist applies direct downward force to the segment.